Suturing and ligating instrument



Sept. 3, 1940- J. J.'ANASTAS| 2,213,830

' I-SUTURING AND LIGATING INSTRUMENT 'Filed Dec. 10, 1938 2 Sheets-Sheetl W 1 TN ESSES INVENTOR: John Joseph flnasiasi,

.4 TTORN E Y5.

Sept. 3, 1940.

J. J. ANAsTAsl 2,213,830

SUTURING AND LIGATING INSTRUMENT Filed Dec. 10, 1938 2 Sheds-Sheet 2 YFIG AT W1 TNESSES:

ATTORNEYS.

Patented Sept. 3, 1940 UNTETB STATES ATENT SUTURING AND LIGATINGINSTRUMENT John Joseph Anastasi, Philadelphia, Pa. Application December10, 1938, Serial No. 244,962

11 Claims.

This invention relates to surgical instruments and more specifically tosuturing and ligating instruments. In the past many forms of instrumentshave been developed for aiding the surgeon in stitching wounds, cuts,incisions and the like. Surgeons have long been interested in means foraccelerating suturing and ligating in order to reduce operation periodsand thereby lessen the shock and strain to the patient. Frequently muchtime is consumed because the surgeons work must be done in awkward andrestricted spaces such as in a deep abdominal operation. Thus it isimportant that a suturing and ligating instrument be capable of easy andefficient operation in a restricted space.

When surgery is being done in an awkward and restricted space, theproblem of positioning or clamping the flesh to be sewed is seriousbecause there is little room for other tools. Also in ligating a bloodvessel, an instrument which will clamp the blood vessel as part of theoperation of passing the thread around the vessel is desirable. Thus asuturing and ligating instrument which avoids the use of an additionalclamping or positioning means greatly aids the surgeon.

When a thread has been passed through flesh it is not always easilyaccessible to the surgeon for pulling through or tying off; and hence itis desirable that a suturing and ligating instrument operate in such amanner that a thread passed through flesh or around a blood vessel bepresented to the easy grasp of the surgeon.

This invention is directed to the fulfillment of the above des-ideratain suturing and ligating instruments. The main object of my invention isthe provision of a simple and rugged instrument which may be operated byone hand in awkward and restricted spaces to quickly pass a threadthrough flesh or around a blood vessel. Another object is the provisionof such an instrument which will preliminarily grasp the flesh to besewed or the blood vessel to be ligated and as the final step in itsoperation present the thread to the easy grasp of the operator. Anotherobject is the provision of such an instrument in a simple form whichlends. itself to rugged and uncomplicated mechanical structure.

Still further objects and advantages of this invention will becomeapparent from the following detailed description of an embodiment ofthis invention with suggested modifications thereof.

Referring to the accompanying drawings, Fig. I shows a view in sideelevation of an instrument embodying the hereinafter described inventionwith portions in section, and showing the relation of the parts when theseveral members are separated.

Fig. II is an elevation of the instrument with the several members closetogether and the nee dle in the position which it assumes when passedthrough the parts to be sutured or around the blood vessel to beligated.

Fig. III is a partial view of the top portion of the instrument in itsclosed position taken as indicated by the lines III-III in Fig. II.

Fig. IV is a fragmentary perspective view of the upper ends of thelevers comprising the instrument showing the manner in which the nee- 15dle is mounted.

Fig. V is a fragmentary view of one of the han dies of the instrumentshowing the clip holding a portion of the thread in place and taken asindicated by the lines V-V in Fig. I.

Fig. VI is a section taken along the lines VI-VI of Fig. I.

Fig. VII is a side elevation of the needleand its operating link formedintegrally therewith showing a portion broken away at the point of theneedle to expose the eye.

Fig. VIII is a side elevation of a modified form of the invention withportions broken away to show internal structure.

Fig. IX is a side elevation of a further modification of this inventionwith portions broken away to show internal structure.

Fig. X is a perspective view of a thread clip showing the thread caughtas the needle is Withdrawn after having passed the needle through fleshto be sutured or around a blood vessel to be ligated.

Fig. XE is a sectional View of the device shown in Fig. X and takenalong the lines XI-XI therein.

Fig. XII is a sectional View similar to that shown in Fig. XI showingthe clip spread by the needle; and

Fig. XIII is a top view of the device shown in Fig. XII as spread by theneedle.

In the following detailed description of the embodiments of thisinvention shown in the drawings, specific terms will be employed for thesake of clarity, but it is to be understood that such terms are used ina descriptive sense and not for purposes of limitation. Each specificterm is intended to include all technical equivalents which operate in asimilar manner to accomplish a similar purpose.

The instrument shown in Fig. I comprises a gripping lever i, a needleoperating 1ever2, a

secondary gripping lever 3, all of said levers being pivotally connectedby a screw 4, a needle operating link 5, a needle 6, a spring 1 and athread 8. It will be seen that this instrument is generally similar tothe usual metal forcep-type of instrument with handles H and I2 providedat the lower ends of the levers I and 2. The selection of materials forthe manufacture of this instrument may be left to those skilled in thesurgical instrument art. On the lever 2 there is provided an abutment 3for contacting with the lever i when the instrument is in the closedposition to prevent the application of undue pressure by an operator whounintentionally forces the instrunormally open position of theinstrument the' ment in its closed position.

On the lever I there is provided a thread clip Hi for controlling thethread during the suturing or ligating operation. Obviously, the clip isand the abutment 83 may be on either lever i or 2. The upper endofgripping lever I is bifurcated as shown at i5 to receivetheineedle'fi-between.

the-branches of said bifurcationn The inside of the upper end of thegripping lever is provided with points 46 which are alignedwith thepoint of the needlefi in order that flesh may begripped between thepoints it and the point of the needle 6.- Cooperating teeth I! areprovidedon the-inner ends of both levers l and 3 toprovide a firm gripon flesh being sutured, or on a blood vessel being ligated.

The needle operatinglinkB is pivotally'attached at one end to the'leverSat was shown: The. bottom portion ofthelink 5 is in sliding engagementwith a groove formed in the end of the lever 2 between the branches of abifurcation thereof. It will be noted that the link 5 is curveddownwardly on a curvature similar to that of the needle 6; and the.sliding action of: the lever 2 along this are of the linkf5 has inpractice been r-found to provide an easy and smoothv operation of theinstrument. The needle 6 which is formed integrally with the link- 5forms an elbow is therewith and on the inside-of this elbow [9 a;

stop 20-is attached to and extended between 'the branches of thebifurcation in'the end of the lever 2, thus limiting the distancewhich'the lever 3 may be separated from the lever 2 to the length:

of the link 5.

In the normally open position of the instrutment these levers 2 and 3are maintained in the i open position by means of the spring 7 "attachedat oneend to the lever 3 and in sliding engagement at the other endthereof with the lever'2."

It is obvious that the springs? could be:reversed and attached tothelever 2-or that another type of spring could be provided such as acoil type. Additional spring'rmeans for urging the levers 3 and"2 apartwill occur to one skilled in the art;

The lever 3 is also bifurcated at the end thereof to-receive the needle8 between the branches-of the-bifurcation; and it is to be noted that inthe point ofthe needle 6 projects a-limited'distance beyond the lever 3"and into the space between the ends of the lever i and the lever 3,thus providing a positioning point -to cooperate in a gripthe needleoperating link 5=is of a usual curved ;form and type having: an eye,22..near the end 'lfi 'this type is used for suturing or ligating in athereof. The specific curvatureof-the needle-'5, however, issignificant. When an instrument of space which is deep and diificult ofaccess, it appears that, in the case of the prior art devices, evenafter the needle carries the thread through the flesh to be sewed therewill be difiiculty in catching the end of the thread which is notcarried up toward the operator. One of the outstanding advantages ofthis invention is that the needle 5 is so formed and so operated thatwhen the instrument is fully closed the end of the needle 6 swingssharply up toward the operator with the thread 53 in the end thereof.This makes it easy for the operator to grasp the end of the thread 3.-This is particularly so when the needle 6 is properly threaded from thetop with the end of the thread 8 pointing toward the operator.Therefore, the needle 6 is curved along an arc of a circle having acenter at the pivotal point 98 Where the link 5 is attached to the lever3. It is to be noted that the curved needle 6 must be swung about acircle coinciding substantially with the'circle formedby thecontinuation oi-saidarc'of the needle inorder to avoid tearing,

It is to the holes formed by the needle point. be furthernoted that theradius of this circle governing the character of the curvature of theneedle 6 is substantially less than the distance between the pivotalpoint i 8 and the pivotal point i wherethe levers i, 2 and'3 areconnected. It is thus possible in this instrument to-providerelativelylong gripping levers i and 3 with a needle ii having a curvaturegoverned by an are formed, on a relatively short radius. the needle 6were formed on a much flatter arc the point with thethread 3 would notbe pre- 'sented so directly to the grasp of theoperatorof the instrumentasthe instrument is closed.

It should be notedthat the spring '7 should be.

sufficiently weakthat the teeth H will grip the flesh or blood vesselfirmly without crushing as theneedlet is operated and this is; ofcourse,'a

strument to an incision or other flesh to: be"

sutured, he first sees that the thread 8 is .in place as shown in Fig Iof the drawings with" one end projecting substantially through theneedle:

eye 22. He may,-if it suits his convenience, clip the standing part ofthe thread 8 in place by the use of clip Men the handle portion ofleverI. The surgeon now takes the instrument and using It is clear that if itas a forcep grasps theflesh to be sutured between the points it onthelever i and the projecting point of the needle ii. This enables thesurgeonto firmly position his instrument beforeactually passing theneedle 'ithrough the flesh.

I When the surgeon has satisfied himself that the flesh isproperly-positioned for a suture at-the points grasped by hisinstrument, he further compresses the handles it and. i2 bringing theteeth it into play for a more firm grasp of the surrounding flesh to besutured. A further compression of the handles ii and i2 will cause thelever 2 to swing the link '5 about its pivot 58-- urging the needle 6through the flesh, the point of the needle 6 passing between thebranches'of the bifurcation on the end of the lever i. In its closedposition the instrument will appear as shown in Fig. II with the end ofthe thread 8 presented to the easy grasp of the operator by the end ofthe needle 6 which swings up toward L the operator. The surgeon nowdisengages the end of the thread 8 from the needle eye 22 and then opensthe handles H and i2 which releases the grasp of the instrument on theflesh and by means of the stop 28 engaging the elbow 19 re tractstheneedle 6 from the pierced flesh. The thread 8 is then cut and the suturecontinued in the usual manner. To repeat the operation the surgeonsimply again threads the needle 6 by passing the end of the thread 8down through the needle eye 22 from the top as before.

If the instrument is used for ligating, the blood vessel to be ligatedis grasped firmly between the gripping levers and 3 by the teeth I!while the needle 6 is urged around the blood vessel carrying the end ofthe thread 8 around the blood vessel and up toward the operator to begrasped and manipulated as explained above in regard to the performanceof the suturing procedure. It is thus clear that this invention providesa simple and rugged form of instrument which efficiently passes thethread for the surgeon in performing either a suturing or ligatingoperation, presenting the end of the thread 8 to the easy grasp of theoperator as the final step in the operation of the instrument.

The above described embodiment of this invention can be modified by theprovision of a clipping means on the end of the lever which issubstituted for the bifurcation described above. This clipping means isclearly shown in Figs. X, XI, XII and XIII and consists of a spring 25riveted to the end of the lever I and an element 2E5 riveted to thespring 25. The element 26 is in effect a movable corner of the end ofthe lever I mounted on a spring 25 holding it in place with capacity forbeing sprung out. In order to guide the point of the needle 6 into placeto spread the element 26 outwardly, the adjacent corners of the element26 and the lever l on the side facing the lever 3 are rounded off. Inother respects the lever I equipped with this modification is the sameas the bifurcated type with points l6 and teeth ll formed thereon.

In operation the needle 6 simply spreads the element 26 from the lever land when retracted the thread 8 is caught as in any spring clip. By thismeans, the end of the thread 8 may be pulled out by the instrumentitself to be more accessible to the operator after the needle 6 has beendisengaged from the flesh. This avoids all need of any additionalinstrument to grasp the end of thread 8.

Figs. VIII and IX are two simplified modifications showing differentways of mounting the needle operating link 5. In Fig. VIII, the link 5is pivotally mounted at I80. on the gripping lever I instead of on asecondary gripping lever 3 which is omitted in this form of theinvention. This form of the invention operates in the same generalmanner as the embodiment described above except for the absence of thesecondary gripping lever 3.

In Fig. IX, the needle operating link Ed has been pivotally attached tothe needle operating lever 2a. at the intermediate point 58b instead ofon the gripping lever i as in the embodiment of Fig. VIII. The operatinglink 5a is pivotally attached at an intermediate portion thereof insteadof at the end; and at its outer end, an elongated slot 32 is formedwhich engages with a pin 3| mounted on the lever l. The operation of thelink 5a and needle 6 will be understood from the above description ofthe other embodiments of this invention. It is to be noted that in. boththe embodiments of Figs. VIII and IX the curvature of the needle 6 isdetermined in the same way as the curvature of needle 6 is determined inthe embodiment of Figs. I and II described above and for the samepurpose.

Certain illustrative embodiments of this invention have been describedabove in considerable detail but it is to be understood that manychanges and variations may be made therein, as will occur to one skilledin the art, without .cparting from the spirit of the invention ashereinafter claimed.

Having thus described my invention, I claim:

1. A suturing and ligating instrument comprising pivotally connectedprimary and secondary gripping levers, cooperating with aneedleactuating lever, a combination link with an elbowed needleportion, said link being pivotally attached to one of the grippinglevers, the needle actuating lever having sliding engagement with saidlink and the needle portion being curved a substantial distance from thepoint thereof according to an arc of a circle having. as a center thepivotal point of said link, and a point formed on the end of one of thelevers aforesaid to coact with the needle point in. a gripping action.

2. The invention of claim 1 wherein the operating link portion is formedon an are having a curvature similar to that of the needle.

3. A suturing and ligating instrument comprising primary and secondarygripping levers, cooperating with a needle actuating lever, allfulcrumed on a common pivot, a combination link embodying arelatively-elbowed thread carrying needle pivotally attached to one ofthe gripping levers and having sliding engagement with theneedle-actuating lever whereby said link may be swung on its pivot andthe curve of said link and the curve of said needle for a substantialdistance from the needle point being an arc of a circle having as acenter the point of pivotal attachment of said operating link to one ofsaid levers, and points formed on the end of the primary gripping leverto jointly coact with said needle point in effecting a suture orligature grip.

4. A suturing and ligating instrument comprising a primary and secondarygripping levers, cooperating with a needle actuating lever, said threelevers being all pivotally mounted on a common center, a link pivotallyconnected to the secondary gripping lever and in sliding engagement withthe needle-actuating lever, a threadcarrying needle forming a part ofsaid link, means for limiting movement of the secondary gripping leverwith relation to the needle actuating lover, a spring normally urgingthe secondary gripping lever to said limit away from the needleincluding link, and the point of said needle being positioned to move incooperative relation with the ends of the gripping levers.

5. A suturing and ligating instrument comprising a primary grippinglever, a needle operating lever, a secondary gripping lever, said leversbeing all mounted on a common pivot pin, an operating link pivotallyconnected to the secondary gripping lever and in sliding engagement withthe needle operating lever, said operating link including a curved.thread-carrying needle in continuation of the said link and forming anelbow therewith, a limiting stop mounted on the needle operating leverfor engaging the elbow to limit movement of the secondary grippinglever, a spring urgingthe secondary gripping lever to the limit positionaway from the needle operating lever, and openings in the ends of thegripp-ing levers for passage of the needle therethrough in operation.

6. A suturing and ligating instrument in accordance with claim 5,wherein the thread-carrying needle is curved a substantial portion ofits length on the arc of a circle having as a center the pivotal pointof said operating link.

7. A suturing and ligating instrument as defined in claim 1, wherein theend of the secondary gripping lever has mounted thereon a springinfluenced thread clip which is normally closed, said clip beingdesigned to open by passage of the needle therethrough in operation ofthe instrument, and to close by recoil action as said needleis'withdrawn thereby to grip the thread carried by the needle.

-8. A suturing and ligating instrument as defined in claim 5, whereinthe thread carried by the needle passes through a hole near the freeend'of said needle, and a clip is mounted on one of the leversconvenient to the operators hand to hold the thread during operation ofthe instrument.

3. A suturing and ligating instrument comprising a primary and secondarygripping levers, cooperating with a needle actuating lever, said threelevers being all mounted on a common pivotal pin, a link pivotallyconnected to the secondary gripping lever and in slidingengegement withthe needle actuating lever, a thread carrying needle in continuationoisaid link, said thread carrying needle being curved a substantialdistance from the point thereof according to an are drawn with a centerat the pivotal connection of the aforesaid link, such curvature radiusbeing substantially shorter than the distance between the pivotalconnection of the link and the pivotal connection of the several levers,means for limiting movement of the secondary gripping lever withrelation to the needle including link, spring means normally urging thesecondary gripping lever to its limit away from said link, and the pointof said needle being positioned to move in cooperative relation with theends of the gripping levers. A

10. A suturing and ligating instrument in accordance with claim 1,wherein the primary gripping lever outer end is bifurcated to formspaced points for cooperation with the point of the needle in jawaction.

11. A suturing and ligating instrument in accordance with claim 5wherein a portion of the end of the primary gripping lever is cut awayand a spring clip is fastened to said gripping lever, said spring clipand the adjacent edge of the lever cut away being opposedly rounded sothat the needle point is guided into and received between the clip andsaid gripping lever cut away as the spring clip is sprung outwardly, andthe thread is caught between the clip and the gripping lever cut away asthe latter is retracted. I

' JOHN JOSEPH ANASTASI.

